Getting More Aggressive with Clavicle Fractures

Huffington Post—April 2, 2009

On Lance Armstrong's way to becoming one of the greatest cyclists of all time, he has overcome many obstacles. This week he faces a new one: recovering from surgery for a broken clavicle. The clavicle, or collarbone, is the bone between one's sternum and scapula (or shoulder blade). It plays an important role in the function of the shoulder girdle and serves to protect major blood vessels and nerves.

Clavicle fractures are very common injuries, accounting for about 5% of all fractures seen in emergency departments. They most frequently occur in the middle of the bone, and in adults, they usually result from forceful, direct impact to the bone.

Clavicle fractures are extremely painful. Patients may present with swelling, tenderness, bruising and/or deformity of the bone. In severe cases, the break can lead to compromise of the underlying neurovascular structures or even of the lung, which can cause problems breathing. Diagnosis is confirmed with xrays.

Although these fractures are very painful, the majority can successfully be treated with conservative measures, particularly non- and minimally-displaced fractures (meaning the pieces of bone haven't moved too far apart from one another). Patients are placed in a sling and given pain medications. Often they can return to training for sports at about 6 weeks after the injury. If one goes back before the bone heals, there is clearly an increased risk of re-fracture.

Some of the indications for surgery include significant displacement of the bone ends such that they are tenting the skin, injury to the surrounding neurovascular structures, and fractures that come through the skin (or open fractures). Oftentimes, athletes are treated surgically to get them back to their sports more quickly. According to Dean Lorich, an orthopedic surgeon at Hospital for Special Surgery, "Academically the reason to fix clavicle fractures is improved strength, endurance and cosmesis. The displaced clavicle can lead to significant shoulder asymmetry when healed (i.e., shortened shoulder) and large bump." Lorich adds that "patients treated operatively are some of the most grateful patients I have, as their pain and disability disappear almost immediately." Acutely, in most cases, he "prefers to use an intramedullary nail instead of a plate and screws, as it is done minimally invasively and almost never requires removal of the plate."